PALLIATIVE CARE EDUCATION THROUGH QUALITY IMPROVEMENT

DESCRIPTION: Significant advances have been
made in the management of pain and other symptoms in the terminally
ill. Studies locally and in the medical literature, however, indicate
that large numbers of patients have in adequate relief of pain and
other problems prior to death. Quality in palliative care, is
dependent on a complex health care delivery system, and the
coordination of an interdisciplinary team of providers,in addition to
adequate knowledge and skills. In order to improve palliative care
delivery, physicians must be able to work within a team and need to
understand improvement of health care delivery processes. In this
project, medical students, as part of a longitudinal clinical
experience, will participate in an interdisciplinary quality
improvement team with nurses, staff physicians, hospice team members,
support staff and resident physicians to develop a critical pathway
for palliative care at three hospitals. The critical pathway will
identify steps for delivery of care to terminally ill cancer patients,
and will provide on-going education about the process for palliative
care to those involved in caring for these patients. Medical
students will gain a global understanding of care of the dying from
hospice staff, patients and families, hospital staff and chart reviews
as part of the data collection for the quality improvement process.
A problem-based and interactive curriculum supplements this knowledge.
Once developed, a critical pathway for palliative care and the
process for integration and ongoing improvement of the pathway will
be disseminated to other institutions through the Norris Cotton Cancer
Center oncology outreach program, the Vermont Program for Quality in
Health Care, and the Veterans Administration National Ethics Center. Our specific aims are to: 1) Develop an ongoing palliative care
education program for medical students, resident and staff physicians
and other healthcare professionals including hospice team members.2)
Foster an understanding for medical students of interdisciplinary
healthcare teams, and means of improving healthcare systems through
quality improvement efforts.3) Use a continual improvement process
to develop a critical pathway for delivering palliative care in
three settings, the White River Junction VA Medical Center, the
Mount Ascutney Hospital and the Dartmouth Hitchcock Medical Center.
Create self-perpetuating palliative care quality improvement through
implementation of the critical pathway and ongoing evaluation and
modification of the pathway.